Premier Talent NW

Please fill out this form completely to request a speaker for your event. All information will be kept in strict confidence.
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Organization
Contact Name
Phone Number (with area code)
Address
City
State	Zip Code
Email Address
Are you a 501(c) 3? Yes No
Annual Budget
Web site
Purpose of Organization
Alternate Contact Name (in case of an emergency)
Alternate Phone Number (with area code)

Name of Event
Date
Duration	Start Time
Location of Event
Address
City
State	Zip Code
Who do you want to come?
What do you want them to do? Emcee Keynote Speaker Other
Will others be speaking? Yes No	If so, who and what is their role in the event?
What is the event dress code? Formal Business Casual Other
Type of event? What is the goal of the event?
Is parking complimentary? Yes No	If so, where?
Is spouse invited to attend? Yes No
Are accommodations complimentary? Yes No	If so, what's the name and address of the hotel?
Proposed fee	Projected Attendance
How did you hear about Premier Talent Northwest?